Individual provider Active NPI

Amirah Jonadoss, MD

  • Family Medicine Physician
  • Mequon, WI
National Provider Identifier
1356577969
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83172 Issued in WI
Practice address
12203 Corporate Pkwy
Mequon, WI 53092-3388
Phone
(262) 387-8220
Fax
(262) 387-8239
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 83172 WI Primary
Family Medicine Physician 207Q00000X N3766 TX

Addresses

Primary practice location

12203 Corporate Pkwy
Mequon, WI 53092-3388

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
100181565MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ajonadoss403918@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100215000560 TX Practitioner - Family Practice 9537203575 Reassigns benefits to 1 organization
I20240611000691 WI Practitioner - Family Practice 9537203575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

12203 N Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8383

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Jun 12, 2024 Accepting new patients
Premise Health of Texas Medical PA CurrentSince Dec 29, 2012 Accepting new patients
Aurora Advanced Healthcare, Inc. Family Medicine CurrentSince Jun 12, 2024 Accepting new patients
Premise Health of Texas Medical PA CurrentSince Dec 29, 2012 Accepting new patients
Memorial Hermann Health System Past Accepting new patients
Memorial Hermann Health System Family Medicine Past Accepting new patients

Locations

16906 Collection Ctr Dr
Chicago, IL 60693

255 Westlake Park Blvd
Houston, TX 77079
Phone (281) 310-5040

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

Interoperability endpoints

  • Direct secure messaging: ajonadoss403918@direct.myadvocateaurora.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1356577969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12203 CORPORATE PKWY",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923388",
            "telephone_number": "262-387-8220",
            "fax_number": "262-387-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONADOSS",
        "first_name": "AMIRAH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "83172",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N3766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100181565",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajonadoss403918@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "12203 Corporate Pkwy",
            "city": "Mequon",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530923388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.